How to Use

Take this drug exactly as directed by your family doctor . It will work only if taken correctly.

Sublingual tablets must not be chewed, crushed, or swallowed . They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue, between the lip and gum, or between the cheek and gum and let it dissolve there. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.

Buccal extended-release tablets must not be chewed, crushed, or swallowed . They are designed to release a dose of nitroglycerin over a period of hours, not all at once.

• Allow the tablet to dissolve slowly in place between the upper lip and gum - above the front teeth, or between the cheek and upper gum. If food or drink is to be taken during the 3 to 5 hours when the tablet is dissolving, place the tablet between the upper lip and gum, above the front teeth. If you have dentures, you may place the tablet anywhere between the cheek and gum.
• Touching the tablet with your tongue or drinking hot liquids may cause the tablet to dissolve faster.
• Do not go to sleep while a tablet is dissolving because it could slip down your throat and cause choking.
• If you accidentally swallow the tablet, replace it with another one.
• Do not use chewing tobacco while a tablet is in place.

Chewable tablets must be chewed well and held in the mouth for about 2 minutes before you swallow them . This will allow the drug to be absorbed through the lining of the mouth.

For diseaseds using nitroglycerin or isosorbide dinitrate to relieve the pain of an angina attack :

• When you begin to feel an attack of angina starting - chest pains or a tightness or squeezing in the chest, sit down. Then place a tablet in your mouth, either sublingually or buccally, or chew a chewable tablet . This drug works best when you are standing or sitting. However, since you may become dizzy, lightheaded, or faint soon after using a tablet, it is safer to sit rather than stand while the drug is working. If you become dizzy or faint while sitting, take few deep breaths and bend forward with your head between your knees.
• Remain calm and you must feel better in a few minutes.
• This drug usually gives relief in 1 to 5 minutes . However, if the pain is not relieved and you are using:
  • Sublingual tablets, either sublingually or buccally: Use a second tablet. If the pain continues for another 5 minutes, a third tablet may be using If you still have the chest pains after a total of 3 tablets in a 15-minute period, contact your family doctor or go to a hospital emergency room immediately .
  • Buccal extended-release tablets: Use a sublingual - under the tongue nitroglycerin tablet and check with your family doctor . Do not use another buccal tablet since the effects of a buccal tablet last for few hours.

For diseaseds using nitroglycerin or isosorbide dinitrate to prevent an expected angina attack :

• You may prevent anginal chest pains for up to 1 hour - 6 hours for the extended-release nitroglycerin tablet by using a buccal or sublingual tablet or chewing a chewable tablet 5 to 10 minutes before expected emotional stress or physical exertion that in the past seemed to bring on an attack.

For diseaseds using isosorbide dinitrate or extended-release buccal nitroglycerin regularly on a long-term basis to reduce the number of angina attacks that occur :

• Chewable or sublingual isosorbide dinitrate and buccal extended-release nitroglycerin tablets can be using either to prevent angina attacks or to help relieve an attack that has already started.

Dosage

For isosorbide dinitrate
• For angina - chest pain:
  • For chewable dosage form - tablets:
    • Adults 5 mg every two to three hours, chewed well and held in mouth for one or two minutes.
    • Children Dose must be determined by your family doctor.
  • For sublingual dosage form - tablets:
    • Adults 2.5 to 5 mg every two to three hours.
    • Children Dose must be determined by your family doctor.

For nitroglycerin
• For angina - chest pain:
  • For buccal dosage form - extended-release tablets:
    • Adults 1 mg every five hours while awake. Your family doctor may increase your dose.
    • Children Dose must be determined by your family doctor.
  • For sublingual dosage form - tablets:
    • Adults 300 to 600 micrograms - mcg - 0.3 to 0.6 mg every five minutes. If you still have chest pain after a total of three tablets in fifteen minutes, call your family doctor or go to the emergency room right away.
    • Children Dose must be determined by your family doctor.

Missed dose For diseaseds using isosorbide dinitrate or extended-release buccal nitroglycerin regularly on a long-term basis to reduce the number of angina attacks that was happen

• If you miss a dose of this drug, use it as soon as possible. However, if the next scheduled dose is within 2 hours, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Stability and proper storage For sublingual nitroglycerin

• Sublingual nitroglycerin tablets may lose some of their strength if they are exposed to air, heat, or moisture for long periods of time. However, if you screw the cap on tightly after each use and you properly store the bottle, the tablets must retain their strength until the expiration date on the bottle.
• Some people think they must test the strength of their sublingual nitroglycerin tablets by looking for a tingling or burning sensation, a feeling of warmth or flushing, or a headache after a tablet has been dissolved under the tongue. This kind of testing is not completely reliable since some diseaseds may be unable to detect these effects. In addition, newer, stabilized sublingual nitroglycerin tablets are less likely to produce these detectable effects.
• To help keep the nitroglycerin tablets at full strength:
  • keep the drug in the original glass, screw-cap bottle. For diseaseds who wish to carry a small number of tablets with them for emergency use, a specially designed container is available. However, only containers specifically labeled as suitable for use with nitroglycerin sublingual tablets must be using.
  • remove the cotton plug that comes in the bottle and do not put it back.
  • put the cap on the bottle quickly and tightly after each use .
  • to select a tablet for use, pour few into the bottle cap, take one and pour the others back into the bottle. Try not to hold them in the palm of your hand because they may pick up moisture and crumble.
  • do not keep other medication in the same bottle with the nitroglycerin since they will weaken the nitroglycerin effect.
  • keep the drug handy at all times but try not to carry the bottle close to the body. Medicine may lose strength because of body warmth. Instead, carry the tightly closed bottle in your purse or the pocket of a jacket or other loose-fitting clothing whenever possible.
  • store the bottle of nitroglycerin tablets in a cool, dry place. Storage at average room temperature away from direct heat or direct sunlight is best. Do not store in the refrigerator or in a bathroom drug cabinet because the moisture usually present in these areas may cause the tablets to crumble if the container is not tightly closed. Do not keep the tablets in your automobile glove compartment.
• Keep out of the reach of children.
• Do not keep outdated drug or drug no longer needed. Be sure that any discarded drug is out of the reach of children.

For isosorbide dinitrate and buccal extended-release nitroglycerin

• These forms of nitrates are more stable than sublingual nitroglycerin.
• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the drug to break down.
• Do not keep outdated drug or drug no longer needed. Be sure that any discarded drug is out of the reach of children.